Healthcare Provider Details

I. General information

NPI: 1871237107
Provider Name (Legal Business Name): CASA DEL REY ASSISTED LIVING CARE HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22284 N 102ND LN
PEORIA AZ
85383-2657
US

IV. Provider business mailing address

22284 N 102ND LN
PEORIA AZ
85383-2657
US

V. Phone/Fax

Practice location:
  • Phone: 623-266-4934
  • Fax: 623-271-8325
Mailing address:
  • Phone: 623-266-4934
  • Fax: 623-271-8325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: DOINITA DORINA DAWSON
Title or Position: MANAGER ASSISTED LIVING
Credential: OWNER
Phone: 602-446-8139